Super Dermatology LLC
Dermatology in Conyers, GA. Organization (NPI-2).
NPI number1669971776
StatusActive
Last updated in NPPESFeb 3, 2018
Details
- NPI
- 1669971776
- Entity type
- Organization (NPI-2)
- Legal business name
- Super Dermatology LLC
- Organization subpart
- No
- Enumeration date
- Feb 3, 2018
- Last updated
- Feb 3, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | 60121 | GA | Yes |
Practice location
1364 Wellbrook Cir NeConyers, GA 30012-3872
Phone 770-285-3533
Mailing address
1351 Audubon Ct SwAtlanta, GA 30311-2471
Phone 706-840-4554
Authorized official
Dione Marcus Super
Owner
7702853533
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